Presentation on theme: "Computed tomography scan of the abdomen shows a large cystic mass in the abdomen and pelvis without solid tissue or septations (measurement: 43×20×31-cm."— Presentation transcript:
1 Computed tomography scan of the abdomen shows a large cystic mass in the abdomen and pelvis without solid tissue or septations (measurement: 43×20×31-cm ). (+) R hydronephrosisComputed tomography scan of the abdomen shows a large cystic mass in the abdomen and pelvis without solid tissue or septations.
2 Postsurgical specimen showing a large cyst filled with fluid.
3 Eleven liters of clear fluid were aspirated from a paraovarian cyst arising from the left fallopian tube.A left salpingectomy was performed with ovarian sparing.The surgical pathology report defined the mass as a serous cystadenoma with no malignant cells.The hydronephrosis was believed to be due to compression by the mass.
5 Ovarian tumors comprise 1% of neoplasms in children and adolescents, and 75% of such lesions are benign.Ovarian neoplasms are categorized based on their tissue of origin: epithelial, germ cell, or stromal.The most common ovarian neoplasm in adolescents is a benign teratoma, a germ cell tumor.
9 DiagnosisThe primary imaging study for assessment of ovarian cysts specifically is transabdominal or transvaginal ultrasonography.
10 On ultrasonography, a benign cyst typically is unilocular, with a thin, smooth wall and no solid elements.4.4 x 3.4 cm clear ovarian cyst
11 Features of malignant masses: Thickened walls Septations Solid componentsUltrasound examination revealed a mass of mixed echogenicity in the right adnexa (arrows). UB = urinary bladder
12 DiagnosisIn cases when lesions are indeterminate, MRI or CT scan can provide clarification.A mass is diagnosed definitively by histologic examination.
13 Stage I:Growth limited to the ovariesStage IA:Growth limited to 1 ovary, no tumor on the external surface, capsule intact, no ascites present containing malignant cellsStage IB:Growth limited to both ovaries, no tumor on the external surfaces, capsules intact, no ascites present containing malignant cellsStage IC:Tumor either stage IA or IB, but with tumor on surface of 1 or both ovaries with capsule ruptured,* with ascites present containing malignant cells, or with positive peritoneal washings
14 Stage II:Growth involving 1 or both ovaries with pelvic extensionStage IIA:Extension and/or metastases to the uterus and/or tubesStage IIB:Extension to other pelvic tissuesStage IIC:Tumor either stage IIA or IIB, but with tumor on surface of 1 or both ovaries, with capsule(s) ruptured,* with ascites present containing malignant ovaries, or with positive peritoneal washings
15 Stage III:Tumor involving 1 or both ovaries with histologically confirmed peritoneal implants outside pelvis and/or positive retroperitoneal or inguinal nodes; superficial liver metastasis; tumor limited to true pelvis, but with histologically proven malignant extension to small bowel and omentumStage IIIA:Tumor grossly limited to the true pelvis, with negative nodes, but with histologically confirmed microscopic seeding of abdominal peritoneal surfaces or histologically proven extension to small bowel mesenteryStage IIIB:Tumor of 1 or both ovaries with histologically confirmed implants, peritoneal metastasis of abdominal peritoneal surfaces ≤ 2 cm in diameter; nodes are negativeStage IIIC:Peritoneal metastasis beyond the pelvis > 2 cm in diameter and/or positive retroperitoneal or inguinal nodes
16 Stage IV:Growth involving 1 or both ovaries with distant metastases; if pleural effusion is present, positive cytology must be apparent to allot a case to stage IV; parenchymal liver metastasis qualifies as stage IV disease
17 Treatment Functional cysts: Most are small and resolve on their own, and observation for several menstrual cycles is appropriate.*For cysts that are growing, persistent, or symptomatic, or if malignancy is suspected: cystectomy is indicated.
18 Surgery is the initial modality of treatment for stage I-IVA epithelial ovarian cancer Only a small percentage of women with epithelial ovarian cancer can be treated with surgery alone, which includes patients with stage IA (grade 1) and stage IB (grade 1) serous, mucinous, endometrioid, and Brenner tumorsClear-cell carcinomas are associated with a significantly worse prognosis in stage I; all patients with this histologic subtype should be considered for chemotherapyWomen at any stage of epithelial ovarian cancer should be considered for clinical trials if available
19 ReferencesPediatrics in Review Vol. 31 No. 11 November 1, pp (doi: /pir )